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Background and scope of guidance

This guidance is for people over 70 years of age, those who are at very high risk of severe illness from coronavirus (COVID-19) because of an underlying health condition, and for their family, friends and carers.

It is intended for use in situations where the extremely medically vulnerable person is living in their own home, with or without additional support or in long term residential facilities.

Cocooning is a measure to protect people who are over 70 years of age and those who are extremely medically vulnerable by minimising all interaction between them and others.

People over 70 years of age and those with serious underlying medical conditions (as listed below) which put them at very high risk of severe illness from coronavirus (COVID-19) are advised to follow cocooning measures in order to keep themselves safe.

What we mean by extremely medically vulnerable*

people aged 70 years or over

solid organ transplant recipients

people with specific cancers

(a) people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer

(b) people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

(c) people having immunotherapy or other continuing antibody treatments for cancer

(d) people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

(e) people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

people with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

people on immunosuppression therapies sufficient to significantly increase risk of infection

women who are pregnant with significant heart disease, congenital or acquired

*For any essential/key worker, advice should be sought from Occupational Health who can give specific advice on individual conditions.

Cocooning is advised for your personal protection and you will make your own judgement about the extent to which cocooning guidance applies to you. If you are unsure whether or not you fall into one of the categories of extremely medically vulnerable people listed above, you should discuss your concerns with your GP or hospital clinician.

All other people should follow public health guidance on physical distancing.

For members of the public supporting those who are cocooning when they are outside their home, there are a number of things that you can do to help minimise their risk:

keep at a distance

allow them space for walking

avoid physical contact such as shaking hands

In addition, do not take someone who is cocooning for a drive unless you are cocooning with that person. However, if a person needs to attend essential services for example healthcare appointments and has no other means of attending other than getting driven by you, then ensure that appropriate measures are taken to minimise risk of spread such as strict hand hygiene, the use of face coverings for both passenger and driver and keeping as much distance as is practical.

What you need to know

If you are over 70 years of age or have an underlying medical condition listed above, you are at very high risk of severe illness as a result of COVID-19.

Cocooning is a practice used to protect those over 70 and those extremely medically vulnerable people from coming into contact with coronavirus.

It is recognised that you have the right to exercise your own judgement as to the extent to which you consider the cocooning guidance appropriate for you. However, older people (aged 70 years and over) and those with pre-existing chronic conditions have been found to be more susceptible to COVID-19 infection and are most likely to experience severe consequences from infection so it is still recommended that you remain cocooned for your safety. Should you wish to visit someone, receive visitors in your home, visit shops, and engage in other outdoor activities, you should continue to strictly adhere to the public health and social distancing guidance.

It important to note, that the measures outlined below are to minimise risk of COVID-19 infection but as with any social interaction, risk cannot be completely eliminated.

If you choose to go for outside for exercise you should:

strictly adhere to 2 metres physical (social) distancing measures

avoid close face-to-face contact

avoid touching people or surfaces

wash your hands on returning home

If you choose to go for a drive, you should adhere to the following measures:

stay local and within a 20km distance from your home

don’t share the journey with anyone who is not cocooning with you

strictly adhere to the 2 metres physical (social) distancing measures when out

wash your hands on returning home

The use of public transport is to be avoided if possible, should only be used in non peak times and where a physical distance of 2 metres can be maintained. Face coverings should be used, and wash your hands on returning home.

If you need to attend essential services for example healthcare appointments and have no other means of attending other than getting a taxi, the following measures can be taken to minimise risk of spread:

indicate to the driver in advance that you are cocooning

maintain strict hand hygiene

the use of face coverings for both passenger and driver

keeping as much distance as is practical

Shops are now opening up to customers and many of these shops plan to have dedicated hours for those who are cocooning.

If you choose to go shopping, it is best to adhere to the following measures:

attend shops that provide dedicated hours for those who are cocooning which will enable you to do your shopping in a safer way

ideally wear a face covering

strictly adhere to the 2 metres physical (social) distancing measures when out

wash your hands on returning home

If other services, for example the library service can provide dedicated hours for those cocooning then it is reasonable to attend for short periods, taking the necessary precautions regarding physical distancing, hand washing and face covering.

You can also have a small number of visitors to your home (outdoors as much as possible), ideally from a core group of family or friend who are aware of your circumstances and willing to adhere to protective measures while you cocoon. In addition, visitors must not visit you if they are unwell, should keep at least 2 metres away from you, wash their hands with soap and water for at least 20 seconds on arrival to your house and should wear face coverings.

If you choose to visit other people’s homes, tell them in advance that you are coming, make sure that no one in the household is unwell with COVID-19, ideally wear a face covering, strictly adhere to the 2 metres physical (social) distancing measures and wash your hands on returning home. Make the visits outdoors as much as possible.

You may also attend a funeral of a close relative or friend, but as with any gathering of people, it is important that you maintain strict physical distancing, strictly adhere to 2 metres physical (social) distancing measures, wear a face covering, avoid close face-to-face contact, avoid touching people and wash your hands on returning home.

In general, group activities or group sports should be avoided at this time.

Those who are working remotely should continue to do so and only return to the workplace if appropriate safety measures are in place.

If you are living in a long term residential care facility, talk to your carer to determine what is the safest option.

Visits from people who provide essential support to you such as healthcare, personal support with your daily needs or social care should continue, but carers and care workers must stay away if they have any of the symptoms of COVID-19. They may find this guidance for health and social care workers
who visit homes useful. All people coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often whilst they are there.

If you have someone else living with you, who does not fit the criteria for cocooning, they are not required to adopt these protective cocooning measures for themselves. They should do what they can to support you in cocooning and they should stringently follow guidance on physical distancing, reducing their contact outside the home. They should wash their hands thoroughly and regularly, especially upon arrival home and observe good respiratory etiquette at all times.

If you care for but don’t actually live with someone who is extremely medically vulnerable you should still stringently follow the public health guidance on physical distancing.

What cocooning is

Cocooning is a measure to protect those over 70 years and those extremely medically vulnerable by minimising interaction between them and others. This means that those who are over 70 years and those extremely medically vulnerable should stay at home as much as possible to minimise all non-essential contact with people who are not cocooning themselves. This is to protect those who are at very high risk of severe illness from COVID-19 from coming into contact with the virus.

If you are over 70 years of age or have a condition which makes you extremely medically vulnerable (as listed above) you are strongly advised to cocoon, to reduce the chance of getting COVID-19 and follow the physical distancing measures.

You should try to identify ways of staying in touch with others and participating in your normal activities remotely from your home.

As a practical measure, if for example a couple over 70 years are both cocooning together, or a household chooses to cocoon as a unit, then ALL members of the household must follow the above steps but in the household they can interact normally. See below the important steps to be followed if you are living with someone who is NOT cocooning in your household.

What you should do if you have someone else living with you who is not cocooning in the household

Whilst the rest of your household are not required to adopt these protective cocooning measures for themselves, we would expect them to do what they can to support you in cocooning and to stringently follow guidance on physical distancing.

you should stay away from other people in your home most of the time in a well-ventilated room with a window to the outside that you can open

if you have to go into the same room with other people at home you should try to keep at least 1 metre (3 ft) and where possible 2 metres away from them

you should clean your hands regularly and practice good respiratory etiquette

if you can, you should use a toilet and bathroom that no one else in the house uses

if you cannot have your own toilet and bathroom, the toilet and bathroom you use needs to be kept clean (see advice below). Another tip is to consider drawing up a rota for bathing, with you using the facilities first

make sure you use separate towels from the other people in your house, both for drying themselves after bathing or showering and for hand-hygiene purposes

if you share a kitchen with others, avoid using it while they are present. If you can, you should take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry the family’s used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and warm water and dry them thoroughly. Do not share cutlery and utensils. When using your own utensils, remember to use a separate tea towel for drying these

clean all surfaces, such as counters, table-tops, doorknobs, bathroom fixtures, toilets and toilet handles, phones, keyboards, tablets, and bedside tables, every day with your usual household cleaning products, like detergents and bleach as these will be very effective at getting rid of the virus. Follow the instructions on the manufacturer’s label and check they can be used on the surface you are cleaning

we understand that it will be difficult for some people to separate themselves from others at home. You should do your very best to follow this guidance and everyone in your household should regularly wash their hands, avoid touching their face, and clean frequently touched surfaces such as door handles and table tops

If the rest of your household stringently follow advice on physical distancing and minimise the risk of spreading the virus within the home by following the advice above, there is no need for them to also cocoon alongside you.

Handwashing and respiratory hygiene

There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including clean your hands regularly - This is one of the most important things you can do.
Do this after you blow your nose, sneeze or cough, and after you eat or handle food.

try not to touch your face or anyone else’s face

cover your mouth and nose with a paper tissue when you cough or sneeze

place used tissues into a plastic waste bag and immediately clean your hands with alcohol hand rub or wash your hands with soap and water for at least 20 seconds

avoid close contact with people who have symptoms

What you should do if you develop symptoms of coronavirus (COVID-19)

The most common symptoms of coronavirus (COVID-19) are recent onset of:

fever (high temperature) and

cough

shortness of breath or difficulty breathing

loss of taste and smell

If you develop the symptoms of COVID-19, seek clinical advice by phoning your GP. In an emergency, call 112 or 999 if you are seriously ill. Do this as soon as you get symptoms. Do not visit the GP, pharmacy, urgent care centre or a hospital unless you are told to do so.

To help us provide you with the best care if you need to go to hospital as a result of catching coronavirus, we ask that you prepare a single hospital bag. This should include your next of kin or emergency contact, a list of the medications you take (including dose and frequency), any information on your planned care appointments and things you would need for an overnight stay (snacks, pyjamas, toothbrush, medication and so on). If you have an advanced care plan, please include that.

How you can get assistance with foods and medicines if you are cocooning

In the first instance, family, friends and neighbours can support you once you adhere to cocooning guidelines and they adhere to physical distancing guidelines. Where possible use online services and shops that have dedicated times for those who are cocooning.

If these options are not available to you, the government is putting in place assistance through the local authorities, working with the voluntary sector services, to ensure you can have access to food, essential household supplies and medicines. Each local authority will publish contact details.

ALONE is providing a telephone support line, seven days a week from 8am – 8pm, for all older people and their families to contact if they would like any advice, reassurance or additional support: 0818222024. This support line is also open to extremely medically vulnerable people.

The support line complements the clinical advice being provided by the HSE through its website and helpline.

If you receive support from health and social care organisations, for example, if you have care provided for you through the HSE or privately, this should continue as normal. Your provider will be asked to take additional precautions to make sure that you are protected. The advice for formal carers is included in the advice for health and social care workers who visit homes.

What you should do if you have hospital and GP appointments during this period

We advise everyone to access medical assistance remotely, wherever possible. However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP, Specialist or other relevant health care professionals to ensure you continue to receive the care you need and determine which of these are absolutely essential.

It is possible that your hospital may need to cancel or postpone some clinics and appointments. You should contact your hospital or clinic to confirm appointments.

Advice for visitors, including those who are providing care for you

Contact regular visitors to your home, such as friends and family to let them know that you are cocooning and that they should not visit you if they are unwell during this time but if they do visit, they should adhere to strict guidance outlined above.

If you receive regular health or social care from an organisation, either through the HSE or paid for by yourself, inform your care providers that you are cocooning and agree a plan for continuing your care.

If you receive essential care from friends or family members, speak to them about extra precautions they can take to keep you safe and about backup plans for your care in case they are unwell and need to self-isolate.

Advice for informal carers, including family carers

If you are caring for someone who is over 70 or extremely medically vulnerable to severe illness from COVID-19, there are some simple steps that you can take to protect them and to reduce their risk at the current time. Ensure you follow advice on good hand hygiene and respiratory etiquette.

only care that is essential should be provided

wash your hands on arrival and often, especially before and after being in contact with the person you are caring for. Use soap and water for at least 20 seconds or use hand sanitiser

avoid touching your face

cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze

put used tissues in the bin immediately and wash your hands afterwards

do not visit or provide care if you are unwell and make alternative arrangements for their care

provide information on who they should call if they feel unwell, write out the phone number of their GP and GP out-of-hours service and leave these prominently displayed

if it is an emergency, call the emergency services at 112 or 999 and remember to tell them that the person may have or has been diagnosed with COVID-19

How you can look after your mental wellbeing

Social isolation, reduction in physical activity, unpredictability and changes in routine can all contribute to increasing stress. Many people including those without existing mental health needs may feel anxious about this impact, including support with daily living, ongoing care arrangements with health providers, support with medication and changes in their daily routines.

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation please contact your keyworker/care coordinator or provider to review your care plan.

It is very easy to become anxious and lonely when you have to spend time on your own but remember, you can always pick up the phone and call a friend. For more information on minding your mental health during the COVID-19 outbreak go to www.hse.ie.
You can also call the Samaritans on Ph: 116 123.

At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.

There are simple things you can do that may help to stay mentally and physically active during this time such as:

try spending time with the windows open to let in the fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight

spend time doing things you enjoy – this might include reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV

Steps you can take to stay connected with family and friends during this time

Draw on support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone or online. Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling, if you want to.

Advice for people living in long-term care facilities, either for the elderly or persons with disabilities

The advice also applies to those over 70 years of age or extremely medically vulnerable persons living in long-term care facilities. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such persons to ensure this guidance is strictly adhered to.

In terms of residents expanding their activities in line with the government road map, it is important that care providers perform a risk assessment with the resident to determine if the person is able to adhere to the recommended public health measures to ensure the safety of the resident and others in the care facility.